脑CT灌注成像在中枢神经系统疾病中应用研究进展
摘要
CT灌注成像(CTPI)通过CT扫描和计算机图像处理既能显示形态学变化,又能反应功能改变,其已广泛应用于中枢神经系统疾病的临床诊断。急性缺血性卒中CTPI可发现缺血半暗带(IP),显示梗死缺血部位、范围,为早期诊断提供依据。CTPI评价颈动脉狭窄后血管的储备及支架术后血管动力学改变,并能对蛛网膜下腔出血(SAH)是否有脑血管痉挛(CVS)高风险患者进行早期识别和评估,以及对颅内肿瘤良、恶性及重型头颅外伤程度进行评价等。
引文
[1]Miles K A.Measurement of tissue perfusion scanning computed tomography[J].Br J Radiol,1991,64(761):409-412.
[2]Hakim A M.Ischemic penumbra:the therapeutic window[J].Neurology,1998,51(S3):544-546.
[3]Koenig M,Klotz E,Luka B,et al.Perfusion CT of the brain diagnostic approach for early detection of ischemic stroke[J].Radiology,1998,209:85-93.
[4]Konig M.Brain perfusion CT in acute stroke:current status[J].Eur J Radiol,2003,45(S1):11-22.
[5]Kamalian S,Kamaliana S,Konstasa A A,et al.CT perfusion mean transit time maps optimally distinguish benign oligemia from true“At-Risk”ischemic penumbra,but thresholds vary by postprocessing technique[J].AJNR Am J Neuroradiol,2012,33(3):545-549.
[6]Teksam M,Cakir B,Coskun M.CT perfusion imaging in the early diagnosis of acute stroke[J].Diagn Interv Radiol,2005,11(2):202-205.
[7]Schaefer P W,Roccatagliata L,Ledezma C,et al.First-pass quantitative CT perfusion identifies thresh olds for salvageable penumbra in acute stroke patients treated with intraarterial therapy[J].AJNR Am J Neuroradiol,2006,27(1):20-25.
[8]Ho C Y,Hussain S,Alam T,et al.Accuracy of CT cerebral perfusion in predincting infarct in the emergency department:lesion characterization on CT perfusion based on commercially ayailable software[J].Emerg Radiol,2013,20(3):203-212.
[9]Huisa B N,Neil W P,Schrader R,et al.Clinical use of computed tomographic perfusion for the diagnosis and prediction of lesion growth in acute ischemic stroke[J].J Stroke Cerebrovasc Dis,2014,23(1):114-122.
[10]Sabarudin A,Subramaniam C,Sun Z.Cerebral CT angiography and CT perfusion in acute stroke detection:a systematic review of diagnostic value[J].Quant Imaging Med Surg,2014,4(4):282-290.
[11]魏有东,吕发金,李琦,等.VCTOSA联合CT灌注成像对急性缺血性脑卒中影像诊断价值[J].中风与神经疾病杂志,2012,29(3):217-220.
[12]Murphy B D,Fox A J,Lee D H,et al.Identification of penumbra and infarct in acute ischemic stroke using computed tomography perfusion derived blood flow and blood volume measurements[J].Stroke,2006,37(7):1771-1777.
[13]贾建平,冀瑞俊.关于急性缺血性卒中溶栓干预若干问题的思考[J].中华神经科杂志,2010,43(12):817-819.
[14]Mackey J,Khatri P,Broderick J P,et al.Increasing use of CT angiography in interventional study sites:the IMSⅢexperience[J].AJNR,2010,31(3):E34.
[15]Aquilla Turk A S,Magarick J A,Frei D,et al.CT perfusionguided patient selection for endovascular recanalization in acute ischemic stroke:a multicenter study[J].J NeuroIntervent Surg,2013,5(6):523-527.
[16]呙登俊,李海林,胡智伟,等.CT灌注成像辅助溶栓治疗对不明发病时间脑卒中患者的临床研究[J].中华危重症医学杂志:电子版,2012,5(5):290-295.
[17]Cho A H,Sohn S I,Han M K,et al.Safety and efficacy of MRI-based thrombolysis in unclear-onset stroke.A preliminary report[J].Cerebrovasc Dis,2008,25(6):572-579.
[18]Kidwell C S,Jahan R,Gornbein J,et al.A trial of imaging selection and endovascular treatment for ischemic stroke[J].N Engl J Med,2013,368(10):914-923.
[19]Lev M H,Seg al A Z,Farkas J,et al.Utility of per fusionweighted CT imaging in acute middle cerebral artery stroke treated with intraarterial thrombolysis[J].Stroke,2001,32(9):2021-2028.
[20]Momjian Mayor I,Baron J C.The pathophysiology of watershed infarction in internal carotid artery disease[J].Stroke,2005,36(3):567-577.
[21]Roham M,Aquil la S T,David B,et al.Effects of carotid or vertebrobasilar stent placement on cerebral perfusion and cognition[J].AJNR,2005,26(7):1772-1780.
[22]严家川,张猛,王延江,等.颈内动脉中重度狭窄支架置入血管成形术后局部脑灌注的变化及意义[J].解放军医学杂志,2011,36(8):0833-0835.
[23]Wintermark M,Flanders A E,Velthuis B,et al.Per fusion-CT assessment of infarct core and penumbra:receiver operating characteristic curve analysis in 130patients suspected o f acute hemispheric stroke[J].Stroke,2006,37(4):979-985.
[24]Frantseva M V,Carlen P L,Perez Velazquez J L.Dynamics of intracellular calcium and fr ee radical production during ischemia in pyramidal neurons[J].Free Radic Bio l Med,2001,31(10):1216-1229.
[25]Su F W,Lin Y J,Chang W N,et al.Predictors and outcome of acute symptomatic cerebral infarctions following aneurysmal subarachnoid hemorrhage[J].J Neurol,2010,257(2):264-270.
[26]李响,李松柏,李春志,等.蛛网膜下腔出血的CT灌注成像研究[J].中国临床医学影像杂志,2010,21(3):157-159.
[27]Mills J N,Mehta V,Russin J,et al.Advanced imaging modalities in the detection of cerebral vasospasm[J].Neurol Res Int,2013,2013:415960.
[28]Rajendran J G,Lewis D H,Newell D W,et al.Brain SPECT used to evaluate vasospasm after subarachnoid hemorrhage:correlation with angiography and trans cranial Doppler[J].Clin Nucl Med,2001,26(2):125-130.
[29]Gonzalez N R,Boscardin W J,Glenn T,et al.Vasospasm probability index:a combination of transcranial Doppler velocities cerebral blood flow and clinical risk factors to predict cerebral vasospasm after aneurysmal subarachnoid hemorrhage[J].J Neurosurgery,2007,107(6):1101-1112.
[30]Sanellia P C,Anumulaa N,Johnsona C E,et al.Evaluating CT perfusion using outcome measures of delayed cerebral ischemia in aneurysmal subarachnoid hemorrhage[J].AJNR,2013,34(2):292-298.
[31]季卫阳,王中,鲁晓杰,等.CT灌注成像在蛛网膜下腔出血后脑血管痉挛诊断中的应用[J].江苏医药,2011,37(4):0427-0429.
[32]Kanazawa R,Kato M,Ishikawa K,et al.Convenience of the computed tomography perfusion method for cerebral vasospasm detection after subarachnoid hemorrhage[J].Surg Neurol,2007,67(6):604-611.
[33]Pina C.Sanelli,Igor Ugorec,Carl E.Johnson,et al.Using quantitative CT perfusion for evaluation of delayed cerebral ischemia following aneurysmal subarachnoid hemorrhage[J].AJNR,2011,32(11):2047-2053
[34]Nabavi D G,LeBlanc L M,Baxter B,et al.Monitoring cerebral perfusion after subarachnoid hemorrhage using CT[J].Neuroradiology,2001,43(1):7-16.
[35]凌华威,丁蓓,张欢,等.CT灌注成像对脑膜瘤诊断分型的临分型的临床价值[J].临床放射学杂志,2006,25(3):209-212.
[36]Dammert S,Krings T,Moller Hartmann W,et al.Detection of intracranial aneurysms with muldslice CT:comparison with conventional angiography[J].Ncuroradiology,2012,46(6):427-434.
[37]White P M,Teadsale E,Wardlaw J M,et al.What is the most sensitive noninvasive imaging strategy for the diagnosis of intracranial aneurysms[J].J Neurol Nenrosurg Psychiatry,2011,71(2):322-328.
[38]Ding B,Ling H W,Chen K M,et al.Comparison of cerebral blood volume and permeability in preoperative grading of intracranial gliomausing CT perfusion imaging[J].Neuroradiology,2006,48(10):773-781.
[39]Grüner J M,Paamand R,Kosteljanetz M,et al.Brain perfusion CT compared with 15O-H2OPET in patients with primary brain tumours[J].Eur J Nucl Med Mol Imaging,2012,39(11):1691-1701.
[40]Khasraw M,Ameratunga M S,Grant R,et al.Antiangiogenic therapy forhigh-grade glioma[J].Chrane Databsse Syst Rev,2014,22(9):CD008218.
[41]Roberts H C,Roberts T P,Lee T Y,et al.Dynamic contrastenhanced CT of hum an brain tumors:quantitative assessment of blood volume,blood flow and microvascular permeabilityreport of two cases[J].AJNR,2002,23(5):828-832.
[42]曾文兵,汪明全,王毅,等,128层螺旋CT全脑灌注诊断脑肿瘤的应用研究[J].临床肿瘤学杂志,2010,8(15):0740-0744
[43]Jain R,Narang J,Schultz L,et al.Permealbility estimate in these add to other perfusion parameters in differentiating from recurrent/progressive rumors?[J].AJNR,2011,32(4):658-663.
[44]Jain R,Scarpace L,Ellika S,et al.First-pass perfusion computed tomography:initial experience in differentiating recurrent brain tumors from radiation effects and radiation necrosis[J].Neurosurgery,2007,61(4):778-786.
[45]Huang A P,Tsai J C,Kuo L T,et al.Clinical application of perfusion computed tomography in neurosurgery[J].J Neurosurg,2014,120(2):473-488.
[46]Wintermark M,Chiolero R,van Melle G,et al.Cerebralvascular autoregulation assessed by in severe head trauma patients perfusion-CT[J].J Neuroradiol,2006,33(1):27-37.
[47]Metting Z,Rdiger L A.Acute cerebral perfusion CT abnormalities associated with posttraumatic amnesia in mild head injury[J].J Neurotrauma,2010,27(12):2183-2189.
[48]Orrison W J,Snyder K V,Hopkins L N,et al.Whole-brain dynamic CT angiography and perfusion imaging[J].Clin Radiol,2011,66(6):566-574.
[49]Murphy A,So A,Lee T Y,et al.Low dose CT perfusion ni acute ischemic stroke[J].Neurotrauma,2014.[Epub ahead of print]
[50]Li Z L,Li H,Zhang K,et al.Improvement of image quality and radiation dose of CT perfusion of the brain by means of lowtube voltage(70KV)[J].Eur Radiol,2014,24(8):1906-1913.
[2]Hakim A M.Ischemic penumbra:the therapeutic window[J].Neurology,1998,51(S3):544-546.
[3]Koenig M,Klotz E,Luka B,et al.Perfusion CT of the brain diagnostic approach for early detection of ischemic stroke[J].Radiology,1998,209:85-93.
[4]Konig M.Brain perfusion CT in acute stroke:current status[J].Eur J Radiol,2003,45(S1):11-22.
[5]Kamalian S,Kamaliana S,Konstasa A A,et al.CT perfusion mean transit time maps optimally distinguish benign oligemia from true“At-Risk”ischemic penumbra,but thresholds vary by postprocessing technique[J].AJNR Am J Neuroradiol,2012,33(3):545-549.
[6]Teksam M,Cakir B,Coskun M.CT perfusion imaging in the early diagnosis of acute stroke[J].Diagn Interv Radiol,2005,11(2):202-205.
[7]Schaefer P W,Roccatagliata L,Ledezma C,et al.First-pass quantitative CT perfusion identifies thresh olds for salvageable penumbra in acute stroke patients treated with intraarterial therapy[J].AJNR Am J Neuroradiol,2006,27(1):20-25.
[8]Ho C Y,Hussain S,Alam T,et al.Accuracy of CT cerebral perfusion in predincting infarct in the emergency department:lesion characterization on CT perfusion based on commercially ayailable software[J].Emerg Radiol,2013,20(3):203-212.
[9]Huisa B N,Neil W P,Schrader R,et al.Clinical use of computed tomographic perfusion for the diagnosis and prediction of lesion growth in acute ischemic stroke[J].J Stroke Cerebrovasc Dis,2014,23(1):114-122.
[10]Sabarudin A,Subramaniam C,Sun Z.Cerebral CT angiography and CT perfusion in acute stroke detection:a systematic review of diagnostic value[J].Quant Imaging Med Surg,2014,4(4):282-290.
[11]魏有东,吕发金,李琦,等.VCTOSA联合CT灌注成像对急性缺血性脑卒中影像诊断价值[J].中风与神经疾病杂志,2012,29(3):217-220.
[12]Murphy B D,Fox A J,Lee D H,et al.Identification of penumbra and infarct in acute ischemic stroke using computed tomography perfusion derived blood flow and blood volume measurements[J].Stroke,2006,37(7):1771-1777.
[13]贾建平,冀瑞俊.关于急性缺血性卒中溶栓干预若干问题的思考[J].中华神经科杂志,2010,43(12):817-819.
[14]Mackey J,Khatri P,Broderick J P,et al.Increasing use of CT angiography in interventional study sites:the IMSⅢexperience[J].AJNR,2010,31(3):E34.
[15]Aquilla Turk A S,Magarick J A,Frei D,et al.CT perfusionguided patient selection for endovascular recanalization in acute ischemic stroke:a multicenter study[J].J NeuroIntervent Surg,2013,5(6):523-527.
[16]呙登俊,李海林,胡智伟,等.CT灌注成像辅助溶栓治疗对不明发病时间脑卒中患者的临床研究[J].中华危重症医学杂志:电子版,2012,5(5):290-295.
[17]Cho A H,Sohn S I,Han M K,et al.Safety and efficacy of MRI-based thrombolysis in unclear-onset stroke.A preliminary report[J].Cerebrovasc Dis,2008,25(6):572-579.
[18]Kidwell C S,Jahan R,Gornbein J,et al.A trial of imaging selection and endovascular treatment for ischemic stroke[J].N Engl J Med,2013,368(10):914-923.
[19]Lev M H,Seg al A Z,Farkas J,et al.Utility of per fusionweighted CT imaging in acute middle cerebral artery stroke treated with intraarterial thrombolysis[J].Stroke,2001,32(9):2021-2028.
[20]Momjian Mayor I,Baron J C.The pathophysiology of watershed infarction in internal carotid artery disease[J].Stroke,2005,36(3):567-577.
[21]Roham M,Aquil la S T,David B,et al.Effects of carotid or vertebrobasilar stent placement on cerebral perfusion and cognition[J].AJNR,2005,26(7):1772-1780.
[22]严家川,张猛,王延江,等.颈内动脉中重度狭窄支架置入血管成形术后局部脑灌注的变化及意义[J].解放军医学杂志,2011,36(8):0833-0835.
[23]Wintermark M,Flanders A E,Velthuis B,et al.Per fusion-CT assessment of infarct core and penumbra:receiver operating characteristic curve analysis in 130patients suspected o f acute hemispheric stroke[J].Stroke,2006,37(4):979-985.
[24]Frantseva M V,Carlen P L,Perez Velazquez J L.Dynamics of intracellular calcium and fr ee radical production during ischemia in pyramidal neurons[J].Free Radic Bio l Med,2001,31(10):1216-1229.
[25]Su F W,Lin Y J,Chang W N,et al.Predictors and outcome of acute symptomatic cerebral infarctions following aneurysmal subarachnoid hemorrhage[J].J Neurol,2010,257(2):264-270.
[26]李响,李松柏,李春志,等.蛛网膜下腔出血的CT灌注成像研究[J].中国临床医学影像杂志,2010,21(3):157-159.
[27]Mills J N,Mehta V,Russin J,et al.Advanced imaging modalities in the detection of cerebral vasospasm[J].Neurol Res Int,2013,2013:415960.
[28]Rajendran J G,Lewis D H,Newell D W,et al.Brain SPECT used to evaluate vasospasm after subarachnoid hemorrhage:correlation with angiography and trans cranial Doppler[J].Clin Nucl Med,2001,26(2):125-130.
[29]Gonzalez N R,Boscardin W J,Glenn T,et al.Vasospasm probability index:a combination of transcranial Doppler velocities cerebral blood flow and clinical risk factors to predict cerebral vasospasm after aneurysmal subarachnoid hemorrhage[J].J Neurosurgery,2007,107(6):1101-1112.
[30]Sanellia P C,Anumulaa N,Johnsona C E,et al.Evaluating CT perfusion using outcome measures of delayed cerebral ischemia in aneurysmal subarachnoid hemorrhage[J].AJNR,2013,34(2):292-298.
[31]季卫阳,王中,鲁晓杰,等.CT灌注成像在蛛网膜下腔出血后脑血管痉挛诊断中的应用[J].江苏医药,2011,37(4):0427-0429.
[32]Kanazawa R,Kato M,Ishikawa K,et al.Convenience of the computed tomography perfusion method for cerebral vasospasm detection after subarachnoid hemorrhage[J].Surg Neurol,2007,67(6):604-611.
[33]Pina C.Sanelli,Igor Ugorec,Carl E.Johnson,et al.Using quantitative CT perfusion for evaluation of delayed cerebral ischemia following aneurysmal subarachnoid hemorrhage[J].AJNR,2011,32(11):2047-2053
[34]Nabavi D G,LeBlanc L M,Baxter B,et al.Monitoring cerebral perfusion after subarachnoid hemorrhage using CT[J].Neuroradiology,2001,43(1):7-16.
[35]凌华威,丁蓓,张欢,等.CT灌注成像对脑膜瘤诊断分型的临分型的临床价值[J].临床放射学杂志,2006,25(3):209-212.
[36]Dammert S,Krings T,Moller Hartmann W,et al.Detection of intracranial aneurysms with muldslice CT:comparison with conventional angiography[J].Ncuroradiology,2012,46(6):427-434.
[37]White P M,Teadsale E,Wardlaw J M,et al.What is the most sensitive noninvasive imaging strategy for the diagnosis of intracranial aneurysms[J].J Neurol Nenrosurg Psychiatry,2011,71(2):322-328.
[38]Ding B,Ling H W,Chen K M,et al.Comparison of cerebral blood volume and permeability in preoperative grading of intracranial gliomausing CT perfusion imaging[J].Neuroradiology,2006,48(10):773-781.
[39]Grüner J M,Paamand R,Kosteljanetz M,et al.Brain perfusion CT compared with 15O-H2OPET in patients with primary brain tumours[J].Eur J Nucl Med Mol Imaging,2012,39(11):1691-1701.
[40]Khasraw M,Ameratunga M S,Grant R,et al.Antiangiogenic therapy forhigh-grade glioma[J].Chrane Databsse Syst Rev,2014,22(9):CD008218.
[41]Roberts H C,Roberts T P,Lee T Y,et al.Dynamic contrastenhanced CT of hum an brain tumors:quantitative assessment of blood volume,blood flow and microvascular permeabilityreport of two cases[J].AJNR,2002,23(5):828-832.
[42]曾文兵,汪明全,王毅,等,128层螺旋CT全脑灌注诊断脑肿瘤的应用研究[J].临床肿瘤学杂志,2010,8(15):0740-0744
[43]Jain R,Narang J,Schultz L,et al.Permealbility estimate in these add to other perfusion parameters in differentiating from recurrent/progressive rumors?[J].AJNR,2011,32(4):658-663.
[44]Jain R,Scarpace L,Ellika S,et al.First-pass perfusion computed tomography:initial experience in differentiating recurrent brain tumors from radiation effects and radiation necrosis[J].Neurosurgery,2007,61(4):778-786.
[45]Huang A P,Tsai J C,Kuo L T,et al.Clinical application of perfusion computed tomography in neurosurgery[J].J Neurosurg,2014,120(2):473-488.
[46]Wintermark M,Chiolero R,van Melle G,et al.Cerebralvascular autoregulation assessed by in severe head trauma patients perfusion-CT[J].J Neuroradiol,2006,33(1):27-37.
[47]Metting Z,Rdiger L A.Acute cerebral perfusion CT abnormalities associated with posttraumatic amnesia in mild head injury[J].J Neurotrauma,2010,27(12):2183-2189.
[48]Orrison W J,Snyder K V,Hopkins L N,et al.Whole-brain dynamic CT angiography and perfusion imaging[J].Clin Radiol,2011,66(6):566-574.
[49]Murphy A,So A,Lee T Y,et al.Low dose CT perfusion ni acute ischemic stroke[J].Neurotrauma,2014.[Epub ahead of print]
[50]Li Z L,Li H,Zhang K,et al.Improvement of image quality and radiation dose of CT perfusion of the brain by means of lowtube voltage(70KV)[J].Eur Radiol,2014,24(8):1906-1913.